Unit 2 Flashcards
Early signs & symptoms of Hypothyroidism
Fatigue, cold intolerance, wt gain, dry skin, brittle hair and nails, high DBP
Late signs & symptoms of Hypothyroidism
Slow speech, hoarse, loss of outer 1/3 eyebrow, myxedema, periorbital puffiness, low HR, possible effusions, decreased LOC, cardiac complications
Myxedema
Thickened, shiny skin
Severe form of Hypothyroidism
Myxedema coma
Symptoms of myxedema coma
low temp, low BP, low RR – acute syndrome
General symptoms of hypothyroidism
Hair loss, apathy, lethargy, dry skin, muscle aches, weakness, constipation, cold intolerance, receding hairline, facial & eyelid edema, dull expression, extreme fatigue, thick tongue - slow speech, anorexia, brittle hair & nails, menstrual disturbances
Hypothyroidism treatment
Replacement - Levothyroxine (Synthroid)
May also give steroids
Myxedema coma treatment
Give T4 IV (can use T3 if T4 ineffective, but check for arrythmias and push slow)
What causes a goiter?
Hyperthyroidism
Hyperthyroidism Sx
High HR, High BP, rhythm changes (tachy, maybe Afib), insomnia, heat intolerance, wt loss, sweaty, fine hair, incr. bowel movements/diarrhea, enlarged/palpable thyroid, finger clubbing, tremors, menstrual changes, flushing, breast enlargement, muscle wasting, localized edema
Graves Sx
goiter, pretibial edema and/or myxedema (swelling of skin and surrounding tissues, exopthalmos (bulging eyes)
Severe form of hyperthyroidism
Thyroid Storm
Thyroid storm sx
Change in LOC, diarrhea, increased temp, tachy (>140), pounding heart, tremors, shaking, sweating, fever, high SBP (>160), wide pulse pressure
This condition has 50% mortality
Thyroid storm
Amiodarone can lead to…
Hypo or Hyperthyroidism. Typically normalizes when D/C’d, but may be permanent in some cases.
Primary Hyperthyroidism treatment
- Propranolol - lowers HR and T4/T3 conversion
Secondary Hyperthyroidism treatment
- Propothyouracil (PTU) or methimazole
- both are antithyroid meds used as 1st line tx before ablation of thyroid
3rd line treatment of Hyperthyroidism
- Change diet (increase cals, proteins, and carbs to combat wt. loss and muscle wasting)
- Radioactive iodine (Cat X, used to diagnose nodules and destroy thyroid tissue)
Radioactive iodine precautions
- Keep distance from pt when possible
- Tell pt to avoid close contact for 3 d after
Thyroid storm tx
Beta blocker then PTU wait 1hr, then Iodide then steroids
PTU MOA
Is an antithyroid agent which works by stopping the thyroid gland from making thyroid hormone
PTU potential side effects
Liver damage
How should PTU be used
Typically taken 3 times a day by mouth, may decrease your use of it once your condition is controlled with Dr supervision
Products of the adrenal cortex
Glucocorticoids/Mineralcorticoids, Androgens. Cortisol
Products of the adrenal medulla
Epi and NE
A hyperadrenal condition
Cushing’s
A hypoadrenal condition
Addison’s
Cushing’s Syndrome Def
High cortisol from any cause
Cushing’s Disease Def
High Cortisol from a pituitary cause or tumor
Iatrogenic Cushings Cause
Caused by something outside of the body. Most commonly prescribed steroids
Ectopic Cushings cause
Lung CA can release an ACTH like hormone that causes cushings
Hormone precursor of cortisol:
ACTH
Effects of cortisol on the body
Impaired collagen production, enhanced protein catabolism, anti-insulin effect, inhibitory effect on T-cells, enchanced catecholamine activity
Cortisol effects these body systems:
CV (esp BP), and works on metabolism of fats, carbs, and proteins
Cushings Syndrome and disease Sx
Central obesity, moon face, buffalo hump, poor wound healing, easy bruising, purple striae on abd, acne, HTN, high glucose, high Na, Low K, psychiatric issues, osteoporosis, HTN (80%), cardiac hypertrophy, purpura, edema (Na retention)
Cushings Disease ONLY Sx
Hyperpigmentation, masculinization in females
What is the cause of the symptoms of Cushings disease
Faulty release of melanocyte stimulating hormone during release of increased ACTH
Potential cause of impaired immunity, hyperglycema, and poor protein control
Cushings
Cushings treatment
- reduce corticosteroid use (TAPER)
- meds prior to surgery to control cortisol
- Radiation therapy (used with surgery) - pinpoint adrenal gland or adrenal tumor
- Surgery - tumor removal
This tests for cushings
Dexamethasone suppression
What does a dexamethasone suppression test measure?
Whether ACTH secretion by the pituitary can be suppressed
How does the dexamethasone test work?
Dex is a synthetic steroid similar to cortisol. It reduces ACTH release in normal people so a normal person should have reduced ACTH and cortisol levels following its use. If the pit is producing too much ACTH, the patient may have higher levels of cortisol after the test. Either blood is drawn before and after or urine is collected to evaluate.
Most common primary cause of Addison’s in 1st world
Autoimmune disorder
Most common primary cause of Addison’s in rest of the world
Infection
Aldosterone is also low in this hypoadrenal condition
Addison’s disease
Secondary cause of Addison’s
Iatrogenic: pts on long term steroids can’t produce their own steroids when stressed or upon abrupt withdrawal
How is Addison’s diagnosed?
Measure plasma cortisol.
- If low, check plasma ACTH, aldosterone, and renin
Lab results of Primary Addisons
High ACTH, High Renin, low aldosterone
Lab results of Secondary Addisons
Low ACTH, Normal Renin/Aldosterone
Addisons Sx
- All: wt loss, anorexia, nausea, abd pain
- Low aldosterone (Low Na, High K), hypoglycemia, orthostatis, pigment, changes in hair distribution, weakness
Bronzed pigmentation in Addison’s is caused by:
High ACTH
Severe hypoadrenal condition
Addison’s Crisis (fatal if untreated)
Addisonian Crisis Sx
Severe low BP, Cardiac collapse, Abd pain, Acute Renal Failure, low blood sugar, high levels of potassium –> shock!
What are the causes of Addisonian Crisis?
Stress, trauma, or infection
Addison’s Tx
- All: hormone replacement therapy
- Potential: oral corticosteroids, corticosteroid injections, androgen replacement therapy, sodium
This corticosteroid may be used to replace aldosterone
Fludrocortisone
These corticosteroids may be used to replace cortisol
Hydrocortisone, prednisone, or cortisone acetate
Increased sodium may be prescribed for Addison’s when…
they are in times of stress, such as with operations, infection, minor illness, heavy exercise, hot weather, diarrhea…
Treatment of Addisonian Crisis
- Rapid Response worthy
- IV injections of: Hydrocortisone, saline solution, sugar (dextrose)
